Are You Ready for This? Assessing Parent Readiness Prior to Discharge From the Neonatal ICU

Purpose:
To implement an innovative assessment tool to evaluate and enhance parents' readiness for discharge from the Neonatal Intensive Care Unit (NICU) to reduce safety events at home as well as unscheduled health care use.

Relevance/Significance:
Taking a baby home from the NICU is a milestone that creates angst for the caregiver. Studies demonstrate that parents struggle to recall discharge instructions and do not feel prepared to care for their infant without the support of NICU staff. Approximately 8% of patients discharged from our NICU experience harm after discharge due to lack of parent preparation. Ensuring that parents are adequately prepared is critically important for achieving positive health outcomes.

Strategy and Implementation:
A scoring tool that elicits demonstration and explanation of central elements of newborn care from caregivers was implemented to allow neonatal nurses to quantitatively assess parent readiness and provide customized education prior to discharge. 8 trained RNs use a standard scoring key that includes best practices and anticipatory guidance. Parents self-report preparedness on a survey prior to taking the baby home. Discharge related safety events after discharge are measured through follow-up phone calls.

Evaluation:
34% of NICU families were assessed using the parent readiness assessment tool during the project pilot. Barriers to assessment included time, heavy patient loads, and inability to predict date of discharge. Of the families assessed, the median score was 90%. Parent self-report of preparedness increased significantly. Discharge related safety events did not significantly decrease.

Implications for Practice:
Evaluating parent readiness to care for a high risk infant at home is an essential part of comprehensive discharge preparation in the NICU. A standard tool assessing caregiver preparedness may be useful to identify families requiring additional education.